Calorie counts in college dining halls

Over on the Academy of Eating Disorders listserv, there's been a discussion going about whether it's good (or even just OK) to post calorie counts for food served on campus. I've listened with interest, and a growing sense of frustration and horror, as both researchers and clinicians debate the pros and cons.

What most of them seem to be missing--or deliberately downplaying--is the damage these calorie listings can do, not just for people with eating disorders but for everyone. And especially women. About three-quarters of women say their eating is disordered in some way, and my personal experience (for myself and watching my friends and acquaintances) certainly bears this out.

It gets right up my nose to hear the sometimes pompous arguments made by academics and researchers on an issue like this. Statements like this one: "Awareness doesn't equal obsession." Um, maybe not if you're a 40-year-old male doctor who's never had an eating issue. If you're a woman in today's culture? I beg to differ. Many years ago when I "did" Weight Watchers I was aware that eating on the WW meal plan simply replaced one food issue with another. Instead of constant anxiety about how much and what I was eating and whether I was gaining or losing weight, I became a good little obsessive weigher of foods and follower of instructions. In nine months on the program I never deviated from it once. Not even for a bite. This was a testament not to my willpower or moral virtue but to the deep level of obsession that being hyper-aware of my calorie intake inspired in me.

I'm quite sure I'm not alone in this.

Which is why I was happy to see this article, written by a senior at Yale, arguing against listing calorie counts for food served on campus.

In theory, maybe "awareness" of calories isn't a bad thing. In reality, I can't see the upside.

AED

I was looking forward to live video blogging from the Academy of Eating Disorders conference in Mexico. Alas, it was canceled due to the swine flu epidemic. A good call, but a tough one for AED. Thanks to Judy Banker and all who had to make this difficult decision.

Put your money where your heart is . . .

and consider making a donation to the Academy of Eating Disorders' 2009 scholarship campaign.

One of the sad truths in the field of eating disorders is that there just isn't enough research being done. That's one reason for the relatively ineffective treatments we've got--there's not a lot of money to be made by researching EDs, probably because pharmaceuticals don't typically do much to help. So researchers--especially young researchers--have to find other ways to support their work.

One of the things I really like about the AED as an organization is the ways in which it nurtures research. And this is one of them. Since 2002, the scholarship fund has helped fund more than 50 clinicians and researchers from around the world to work on finding solutions for eating disorders. It's a worthy cause--and tax-deductible, too!

Tell President-elect Obama how you feel

Here's a chance to contribute to the next administration's health care agenda: Take 10 minutes to go to this site and post about an issue you care about. Mental health parity? Health at Every Size? More funding for eating disorders research? Whatever's near and dear to your heart, tell the change team. Today. Really. Because how often do we get a chance like this?

Round-up time!

I've been a Very Bad Blogger recently, for which I am deeply sorry. :-) Here are a few tidbits to tide you over until I can come up with a brilliant new post.

First, 3 new studies looking for participants:

The Mount Sinai Eating and Weight Disorders Program is offering study treatment as part of a federally funded study (Principal Investigator: Katharine Loeb, PhD) for children and adolescents with symptoms of anorexia nervosa. If your child is 10-17 years old, is medically stable, and is developing signs and symptoms of an eating disorder, s/he may be eligible to participate. The study is approved by the Mount Sinai School of Medicine Institutional Board (Protocol 04-0978, approved through 8/31/09). For more information, call Lauren Alfano, 212-659-8724.

The University of Chicago is looking for adolescents with bulimia nervosa and their families for participation in a 6-month outpatient treatment research study. (Principal Investigator: Daniel le Grange, PhD) The purpose of this research study is to identify effective outpatient psychological treatments for adolescents with bulimia nervosa.
To be eligible the child must be between 12 and 18, be living with at least one parent, and have a diagnosis of bulimia nervosa or partial bulimia nervosa. Participating families will engage in 6 months of outpatient therapy for bulimia nervosa at The University of Chicago Hospitals. These treatments have the potential to bring about improvement in eating disorder symptoms. For more information, please call the bulimia nervosa treatment study at (773) 834-5677, email bulimia@yoda.bsd.uchicago.edu, or visit the Treatment of Bulimic Adolescents Study webpage.

The Johns Hopkins Eating Disorders Program is looking for women 18-40 years old with bulimia nervosa interested in a research study funded by the Klarman Family Foundation. (Principal Investigator: Angela Guarda, MD.) The study includes a health assessment, blood testing, and pictures of the brain taken using a medical scanner. Eligible women will be paid up to $400 for their participation and will be offered 6 weeks of outpatient treatment. Please call (410) 955-3863 for more information.


Next, mark another milestone in the Fight Against Good Foods/Bad Foods: Researchers in Spain have found that a handful of nuts added to your diet each day lower cholesterol and other cardiovascular risk factors. Whether this will actually decrease heart attacks and strokes is anybody's guess. The good part from my POV is that it moves nuts back out of the "bad food" category. Someday, somehow, we will abolish those categories . . . and this is a step in the right direction.

And finally, a shameless plug for my upcoming anthology, Feed Me!: The first review is in, and it's a good one, from Booklist. To see it, join the Feed Me! Facebook group--I've posted it there.

Send me your food/eating/body image news to get me through the grading of final projects. Thanks!

We STILL don't get it

I was saddened to read today of a woman in York, England, who died of complications from anorexia. Carole Patrick had struggled with anorexia for 30 years, according to this article. Chronic malnutrition led to osteoporosis, which led to a fall that broke her hip and made it impossible for her to recover when complications developed.

But I was shocked to read this line, buried in the article:

York Coroner Donald Coverdale, recording a verdict of death by misadventure, said her death was the “unfortunate and unintended consequence of a medical condition arguably under her control."

You would think medical people, at least, would understand that anorexia is not a choice. Anyone who's ever watched someone they love suffer with an eating disorder understands this basic fact; why can't the medical profession get it?

A few paragraphs down, a spokeswoman for BEAT, a UK-based organization supporting people with eating disorders, had this to say about anorexia:

. . . disorders such as anorexia were not a “diet gone wrong” or a fad or a fashion. “They are a way of coping with difficult thoughts, emotions or experiences,” she said.

In some ways, this shocked me even more. This is the old psychodynamic perspective on eating disorders, one that has been in vogue for 50+ years. Only thing is, there's absolutely no evidence that it's true.

The latest research points to genetics and heritability as primary factors in eating disorders. EDs run in families. They're associated with clinical levels of anxiety. Many people have difficult thoughts, emotions, and experiences; very few of them develop eating disorders.

I don't expect most people to understand anorexia; we have a lot of educating to do. But I do expect medical people and organizations like BEAT to know better--or to stop speaking for all those with eating disorders.

No evidence-based treatment for anorexia?

According to this study, which is an overview of 40 years of eating disorders treatments, there are still no evidence-based treatments for anorexia nervosa. "A specific form of family therapy (based on the Maudsley model) appears promising," write the study's authors.

Appears promising? Actually, FBT, or the Maudsley approach, has been shown to be successful (85 to 90 percent long-term recovery rates) for treating both anorexia and bulimia. In the last 10 years there have been several good studies on FBT, including this one, this one, and this one.

And yet some of the top researchers in the field are still saying that there is no evidence-based treatment for anorexia, and that the Maudsley approach "appears promising." Which is rather like saying that there appears to be a link between smoking and lung cancer.

After 40 years with no other good treatments, you'd think researchers would jump on this one. So why the damning with faint praise?

Come on, you guys. You're the ones who can get the word out to parents best. You have a moral obligation to spread the word about FBT--the ONLY evidence-based treatment we've got at the moment for treating anorexia. I'll be thrilled if we turn up more treatments that are effective. In the meantime, though, let's use what we've got.

Join the fray . . .

over at BusinessWeek, where there's a somewhat spurious debate going on over whether the media causes eating disorders. Normally I try to stay away from arguments like this, but because it's BusinessWeek, a fairly respectable publication, I think it's worth it to put the point across. Be warned: There are some real trolls commenting over there, so don't visit if you're feeling fragile.

Big Brother has arrived . . . in Japan

This article made my jaw drop over my morning tea. I don't know why--this kind of government intrusion into private lives is the logical consequence of all the anti-obesity hype we're hearing. It's coming here too, I fear, under the guise of a national health plan that ties "wellness" to "consequences."

But here's the thing: In Japan, talk about eating disorders is very hard to come by. I sit on a committee at the Academy of Eating Disorders with international representation, and the member from Japan has talked repeatedly about how hard it is to get any of the media there to write about eating disorders. And how difficult it is to discuss e.d.s in Japan.

And yet the Japanese government is imposing sanctions on those whose waists exceed a randomly set number?

Once again, the connection between the war on obesity and eating disorders scares the hell out of me. For good reason.